Unexplained hepatitis in children: Should parents be concerned?

The rise in these severe and mysterious cases has led the Centers for Disease Control and Prevention to issue a health advisory to physicians so that health care providers can be alert and report cases accordingly.

What should parents know about cases of hepatitis in children? How worried should they be, and what symptoms should they look for? Is there a connection between cases of hepatitis and Covid-19?

To help answer these questions, I spoke with CNN Medical Analyst Dr. Lena Win, MD, an emergency physician and professor of health policy and management at George Washington University’s Milken Institute School of Public Health. She is also the author of Lifelines: A Doctor in the Fight for Public Health and a mother of two young children.

CNN: Let’s start from the beginning. What is hepatitis and how common is it in children?

doctor. Lina One: Hepatitis is inflammation of the liver tissue. There are a number of reasons. People may have heard of hepatitis A, B, and C, which is an infection of the liver caused by infectious hepatitis viruses. Excessive consumption of alcohol, certain medications, and toxins can cause hepatitis, as can some medical conditions. There is also something called autoimmune hepatitis, in which the body’s immune system attacks the liver.

Hepatitis is uncommon in children, especially hepatitis unrelated to one of the hepatitis viruses. This is the reason why cases of unexplained hepatitis have been reported so far. There are not many cases, but they are large enough to warrant a closer investigation.

CNN: How many children have had unexplained hepatitis so far, and what do we know about them?

Wen: As of May 1, the World Health Organization has reported at least 228 probable cases of hepatitis in children with dozens more under investigation. These cases have been found in more than 20 countries.
Twenty-five US states and territories have reported cases, with 109 cases under investigation so far, according to the Centers for Disease Control and Prevention. A week ago, a CDC report analyzed clinical details from one state, Alabama, which has been tracking pediatric hepatitis cases since October.

Nine children with no apparent causes of hepatitis were identified. They come from different locations in the state without specific association with each other. They are all generally in good health, and there are no underlying medical conditions. The average reported lifespan is about 3 years, and ranges from 1 to 6 years.

Three of the nine children in the Alabama group ended up with acute liver failure, a life-threatening condition. Two had liver transplants. According to the CDC, the nine children are currently recovering, including those who have had liver transplants.

CNN: How do so many cases happen from one country?

Wen: we do not know. I suspect there isn’t necessarily anything specific to Alabama, but there may be cases that have not been reported in other states. This is why the CDC has issued its own health advisories, so that doctors can be aware of these cases and report them if they see them.

The United Kingdom was the first to report cases to the World Health Organization. They have been actively looking for cases. Its Health Security Agency has identified at least 163 confirmed cases across England, Scotland, Wales and Northern Ireland. It is likely now that doctors in the United States are aware, more cases may be reported here as well.

CNN: What do we know about the causes of these cases of hepatitis?

Wen: When patients show signs of hepatitis, they usually get a diagnostic test that looks at whether they have hepatitis A, B, or C; whether they have been exposed to toxins and medications; whether they have some signs of autoimmunity; and so on. All of these are negative in children so far.

One factor in common among the nine primary Alabama cases in the CDC report is that they all had blood work showing adenovirus infection. (Two more children have been identified since those nine cases were first reported.)

Given the potential link, that’s why the CDC has issued its own health alert. She advises doctors to look for cases of hepatitis in children and report them to the Centers for Disease Control and state health authorities immediately. It also directs health care providers to order a specific adenovirus test in these children.

CNN: Could these cases be related to Covid-19?

Wen: It seems unlikely. None of the children in the Alabama case series are hospitalized with Covid-19 infection. There is also no link to receiving the Covid-19 vaccine. The UK’s Health Security Agency previously stated that none of the more than 100 cases had been vaccinated so far.

CNN: How worried should parents be, and what symptoms should they be on the lookout for?

Wen: These cases of unexplained hepatitis in children remain very rare. However, some were extremely dangerous. Parents should not be overly concerned but should know that this is something under investigation and then should contact their doctor if they are concerned.

The initial symptoms of hepatitis are nonspecific, which means that many people have these symptoms for other reasons. They include nausea, vomiting, abdominal pain, fever, fatigue, loss of appetite, and joint pain. Later signs include dark urine and light-colored stools (as well as) jaundice – the skin turns yellow and yellow appears in the whites of the eyes and eyelids.

Many children suffer from viral illnesses that can cause digestive upset, fever and fatigue. If your child is unable to retain fluids, this is a sign that you should contact your doctor. Also, if symptoms persist and do not improve, or if your child begins to become lethargic, call your doctor.

The most worrying signs are if you start seeing dark urine, light-colored stools, and yellowing of the skin or yellowing of the whites of the eyes. You should seek immediate medical attention if your child begins to develop general viral symptoms and then proceeds to develop these signs.

CNN: Is there anything that can be done to prevent these cases of hepatitis?

Wen: Since the cause is still unknown, we cannot say what actions will help prevent it from happening. If there is indeed an association with adenovirus, the same strategies we have used throughout the coronavirus pandemic will be helpful, such as washing hands thoroughly with soap and water and urging people to stay home when sick.

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